LGBTQ_Applicant_Data_Form_B2727401.pdf
PDF 2 MB Posted
- Attached to
- Color Ribbon
- Solicitation number
- B2727401
- Issued by
- Pennsylvania
About this file
This is an LGBTQ Applicant Data Form issued by the City of Philadelphia's Procurement Department for a micro purchase opportunity titled "Color Ribbon" in Pennsylvania. The form serves as a voluntary data collection instrument designed to identify companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons interested in conducting business with the City. The document requests applicant information including business name and bid/opportunity number, and instructs that the data collected will be used to identify LGBTQ businesses currently or potentially doing business with the City and to assist in efforts to include LGBTQ certified businesses in the City's vendor database.
The form contains three primary inquiry sections requesting information about LGBTQ ownership and control of the applicant's business, current certification status as an LGBTBE by the National LGBT Chamber of Commerce through the Independence Business Alliance, and any additional third-party certifications held by the applicant such as MBE, WBE, DSBE, or DBE designations. Additionally, the form requests identification of any LGBTBE-certified subcontractors participating in the contract opportunity. The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder, with all items required to be quoted for eligibility. This is characterized as a requirements contract, and applicants are cautioned not to deliver or provide services until receiving formal notification from the department.
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Other files
| File | Type | Posted |
|---|---|---|
| Consent_Authorization_B2727401.pdf | ||
| MP_Terms_and_Conditions_B2727401.pdf | ||
| Seller_SOP_Checklist_B2727401.pdf |
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Text version
1. Is Applicant’s business beneficially owned and controlled by persons who self-identify as Lesbian, Gay, Bisexual, Transgender or Queer?
2. Is Applicant’s business currently certified as a Lesbian, Gay, Bisexual, Transgender, Business Enterprise (LGBTBE) by the National LGBT Chamber of Commerce (NGLCC) through their local Philadelphia affiliate, the Independence Business Alliance (IBA)?
a. If yes, Applicant is currently certified by NGLCC/IBA as an LGBTBE, is Applicant's business also certified by any other third party certifying agency such as Eastern Minority Supplier Development Council (ESMDC), Pennsylvania Unified Certification Program (PAUCP), Disability:IN or Women's Business Enterprise National Council (WBENC)?
If yes please identify the name of the certifying agency and category of certification (e.g., MBE, WBE, DSBE, DBE):
Certifying Agency:
Certification Category:
3. For this contracting opportunity, are any of Applicant's subcontractors certified by NGLCC/IBA? If yes, how many subcontractors are certified as LGBTBE?
Please list all by business name below.
As part of the City of Philadelphia’s commitment to diversity, equity and inclusion in all aspects of City procurement, the City is collecting data to identify the number of companies beneficially owned and controlled by Lesbian, Gay, Bisexual, Transgender and Queer persons who wish to do business with the City (collectively, “LGBTQ businesses”). The data will be used to identify the number of LGBTQ businesses currently doing business with the City. It will also assist in efforts to include LGBTQ certified businesses into the City’s vendor database.
By submitting this form you are agreeing that the City may, in its discretion, use the data submitted for other projects and may cause it to become publicly available.
Response to this form is entirely voluntary.
Applicant Name:
Bid or Opportunity #:
LGBTQ Applicant Opportunity DataLGBTQ Applicant Opportunity Data
CCIITTY Y OF OF PHIPHILALADDELPHELPHIIA
1401 JFJFK K BBllvvdd. . RoRooom m 117700B B - - PhPhiillaaddeellpphhiiaa, , PA PA 1199110022--11668855 www.phila.gov/procurement
| CertifiedLGBTEYes: Y |
| CertifiedLGBTENo: N |
| Certification: |
| LGBTQTypeYes: Y |
| LGBTQTypeNo: N |
| CertifiedNGLCCNo: N |
| CertifiedNGLCCYes: Y |
| LGBTQTypeY: Off |
| LGBTQTypeN: Off |
| CertifiedLGBTEY: Off |
| CertifiedLGBTEN: Off |
| CertifiedNGLCCY: Off |
| CertifiedNGLCCN: Off |
| Subconsultants: |
| BusinessName3: |
| BusinessName4: |
| BusinessName5: |
| Reset: |
| btnContinue: |
| CertifyingAgency: |
| BusinessName: |
| BusinessName2: |
| ApplicantName: |
| BidNumber: |
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